打开APP

Ann Inter Med:揭示颈部药物注射所引发的真菌性脑膜炎

  1. Ann Inter Med
  2. 真菌性脑膜炎
  3. 颈部药物注射

来源:生物谷 2012-11-18 11:41

2012年10月21日 讯 /生物谷BIOON/ --每年有超过200个病人在通过脊髓硬膜外注射药物甲泼尼龙后被诊断出患有真菌性脑膜炎。刊登在国际杂志Annals of Internal Medicine的研究报告中,研究者对于该病症提出了详细的临床护理、降低发病风险等措施。

2012年10月21日 讯 /生物谷BIOON/ --每年有超过200个病人在通过脊髓硬膜外注射药物甲泼尼龙后被诊断出患有真菌性脑膜炎。刊登在国际杂志Annals of Internal Medicine的研究报告中,研究者对于该病症提出了详细的临床护理、降低发病风险等措施。

研究者对一位51岁的病人进行了长期的观察研究,该病人寻求医疗护理的原因是因为其脖子在进行硬膜外类固醇注射后出现颈部疼痛甚至扩散至脸部疼痛的表现。而其他病人则由于一定的神经系统症状被送回了救治病房,在此后的一段时间内,这位病人的情况快速恶化,10天后其死亡了,验尸结果显示患者出现了急性的脑部和脊髓损伤。

研究者表示,病人可能是由于感染了突脐蠕孢属的菌种,这是一种真菌。因此临床医生和公共健康组织需要清楚,在病人进行关节或者骨注射感染真菌性脑膜炎后的症状,在该疾病刚刚爆发初期,快速的诊断和治疗方法或许是抑制真菌性脑膜炎以及其并发症的有效措施,当然对于降低病人死亡率也可以带来帮助。(生物谷Bioon.com)

编译自:Aggressive Nature of Meningitis Cases Calls for Heightened Awareness Among Clinicians

PMC:

PMID:

Fatal Exserohilum Meningitis and Central Nervous System Vasculitis after Cervical Epidural Methylprednisolone Injection

Jennifer L. Lyons, MD; Elakkat D. Gireesh, MD; Julie B. Trivedi, MD; W. Robert Bell, MD; Deanna Cettomai, MD; Bryan R. Smith, MD; Sarah Karram, MD; Tiffany Chang, MD; Laura Tochen, MD; Sean X. Zhang, MD, PhD; Chad M. McCall, MD, PhD; David T. Pearce, BS; Karen C. Carroll, MD; Li Chen, MD, PhD; John R. Ratchford, MD, MSc; Daniel M. Harrison, MD; Lyle W. Ostrow, MD, PhD; and Robert D. Stevens, MD

Background: Between 21 May and 26 September 2012, an estimated 14 000 patients received spinal epidural injections with contaminated methylprednisolone from a compounding pharmacy, resulting in a multistate outbreak of fungal meningitis (1). The etiologic agent has since been identified predominantly as Exserohilum species, a dematiaceous fungus, although a case of Aspergillus fumigatus was also reported (1). The clinical and pathologic spectra of central nervous system disease due to Exserohilum remain largely unknown. Objective: To describe findings in 1 of the index cases of fulminant Exserohilum species meningitis due to an epidural cervical injection with contaminated, preservative-free methylprednisolone acetate. Methods and Findings: A 51-year-old woman with a history of neck pain, hyperlipidemia, headaches, and fibromyalgia presented to a local emergency department with new occipital headache radiating to the face 1 week after a cervical epidural steroid injection on 31 August 2012 (Chen L, Lyons JL. Personal communications). She had not received injections previously, had no history of immune compromise or trauma, and was not taking any long-term medications. Physical examination and unenhanced head computed tomography were normal, and she was discharged. No lumbar puncture was performed. She returned the next day with diplopia, vertigo, nausea, and ataxia and was hospitalized. Physical examination was notable only for hoarseness and decreased tendon reflexes; routine serum chemistry and blood counts were normal, and she had no fever. Magnetic resonance imaging (MRI) of the brain on hospital day 1 was normal. By day 3, she remained afebrile but developed slurred speech, right hemiparesis, left facial droop, and anisocoria, prompting repeated MRI. Results showed a punctate focus of diffusion restriction in the pons. Lumbar puncture had an opening pressure of 34 cm H2O, glucose level of 1.998 mmol/L (36 mg/dL) (serum glucose level of 5.828 mmol/L [105 mg/dL]), total protein level of 153 mg/dL, white blood cell count of 850 × 109 cells/L (84% neutrophils and 15% lymphocytes), and negative Gram stain and bacterial culture. Treatment with acyclovir, cefepime, vancomycin, doxycycline, and methylprednisolone was initiated; however, she continued to deteriorate and developed dysphagia, leading to endotracheal intubation and transfer to our tertiary care center on day 4 (Smith BR, Ostrow LW. Personal communications.). Magnetic resonance imaging on transfer showed multifocal areas of restricted diffusion in the pons, midbrain, and cerebellum and diffuse leptomeningeal enhancement (Figure, A and C). Repeat lumbar puncture on day 7 showed a glucose level of 2.719 mmol/L (49 mg/dL) (serum glucose level of 8.436 mmol/L [152 mg/dL]), protein level of 104 mg/dL, and white blood cell count of 72 × 109 cells/L (64% neutrophils, 4% lymphocytes, and 4% monocytes). Polymerase chain reaction testing of cerebrospinal fluid for herpes simplex virus, varicella zoster virus, Epstein–Barr virus, cytomegalovirus, and West Nile virus was negative, as were cryptococcal and histoplasma antigens and cerebrospinal fluid bacterial culture. Repeat MRI of the brain (Figure, B, D, and E) showed new restricted diffusion in the left anterior thalamus, progression of brainstem infarction and edema, and interval development of ventriculomegaly, prompting placement of an externalized ventricular drain that did not result in clinical improvement. Magnetic resonance imaging of the neck (Figure,F and G) showed inflammation and possible fluid collection in the soft tissues at the injection site, although follow-up ultrasonography did not corroborate fluid amenable to tap. On day 9, neurologic examination progressed to absent pupillary, corneal, and gag reflexes, and liposomal amphotericin B was added empirically. On day 10, all brainstem reflexes were lost, and death from neurologic criteria was pronounced. Exserohilum species was reported in the cerebrospinal fluid the same day. Autopsy revealed a grossly necrotic brainstem, and microscopic examination showed angioinvasive, septate fungal hyphae associated with diffuse vasculitis (Figure, H) and hemorrhagic infarction in the brain and spinal cord.

版权声明 本网站所有注明“来源:生物谷”或“来源:bioon”的文字、图片和音视频资料,版权均属于生物谷网站所有。非经授权,任何媒体、网站或个人不得转载,否则将追究法律责任。取得书面授权转载时,须注明“来源:生物谷”。其它来源的文章系转载文章,本网所有转载文章系出于传递更多信息之目的,转载内容不代表本站立场。不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。

87%用户都在用生物谷APP 随时阅读、评论、分享交流 请扫描二维码下载->